Payment Allowance Limits for Medicare Part B Drugs
Effective January 1, 2006 through March 31, 2006
Note 1: Payment allowance limits subject to the ASP methodology are based on 3Q05 ASP data. Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category.  These determinations shall be made by the local Medicare contractor processing the claim.
HCPCS Code	Short Description	HCPCS Code Dosage	Payment Limit	Vaccine AWP%	Vaccine Limit	Infusion AWP%	DME Infusion Limit	Blood AWP%	Blood Limit	Notes
90371	Hep b ig, im	1 ML	$118.235
90375	Rabies ig, im/sc	150 IU	$64.905
90376	Rabies ig, heat treated	150 IU	$68.914
90385	Rh ig, minidose, im	50 MCG	$6.613
90396	Varicella-zoster ig, im	125 UNITS	$110.411
90585	Bcg vaccine, percut	50 MG	$118.161
90586	Bcg vaccine, intravesical	1 EACH	$115.087
90632	Hep a vaccine, adult im	1 ML	$42.184
90633	Hep a vacc, ped/adol, 2 dose	1 ML	$22.644
90634	Hep a vacc, ped/adol, 3 dose	3 EACH	$22.652
90645	Hib vaccine, hboc, im	1 EACH	$21.520
90647	Hib vaccine, prp-omp, im	0.5 ML	$21.520
90648	Hib vaccine, prp-t, im	0.5 ML	$21.782
90655	Flu Vaccine	0.25 ML	$14.678
90656	Flu vaccine no preserv 3 & >	0.50 ML	$15.818	95%	$15.818
90657	Flu vaccine, 6-35 mo, im	0.25 ML	$6.028	95%	$6.028
90658	Flu vaccine age 3 & over, im	0.5 ML	$12.056	95%	$12.056
90675	Rabies vaccine, im	1 ML	$147.203
90691	Typhoid vaccine, im	0.5 ML	$37.519
90700	Dtap vaccine, < 7 yrs, im	0.5 ML	$22.642
90702	Dt vaccine < 7, im	0.5 ML	$17.500
90703	Tetanus vaccine, im	0.5 ML	$21.424
90704	Mumps vaccine, sc	0.5 ML	$19.145
90705	Measles vaccine, sc	0.5 ML	$14.493
90706	Rubella vaccine, sc	0.5 ML	$16.165
90707	Mmr vaccine, sc	0.5 ML	$38.505
90713	Poliovirus, ipv, sc/im	0.5 ML	$25.009
90716	Chicken pox vaccine, sc	0.5 ML	$67.342
90717	Yellow fever vaccine, sc	0.5 ML	$59.460
90721	Dtap/hib vaccine, im	1 EACH	$41.724
90732	Pneumococcal vaccine	0.5 ML	$24.571	95%	$24.571
90733	Meningococcal vaccine, sc	0.5 ML	$86.100
90735	Encephalitis vaccine, sc	1 ML	$88.127
90740	Hepb vacc, ill pat 3 dose im	40 MCG	$113.914	95%	$113.914
90743	Hep b vacc, adol, 2 dose, im	10 MCG	$67.928	95%	$67.928
90744	Hepb vacc ped/adol 3 dose im	1 DOSE	$68.381	95%	$68.381
90746	Hep b vaccine, adult, im	1 EACH	$56.957	95%	$56.957
90747	Hepb vacc, ill pat 4 dose im	40 MCG	$113.914	95%	$113.914
J0128	Abarelix injection	10 MG	$67.394
J0130	Abciximab injection	10 MG	$525.993
J0132	Acetylcysteine injection	100 MG	$1.733
J0133	Acyclovir injection	5 MG	$0.025
J0135	Adalimumab injection	20 MG	$301.766
J0150	Injection adenosine 6 MG	6 MG	$32.568
J0152	Adenosine injection	30 MG	$70.298
J0170	Adrenalin epinephrin inject	1 ML	$0.599
J0180	Agalsidase beta injection	1 MG	$127.200
J0205	Alglucerase injection	10 UNITS	$39.220
J0207	AMIfostine	500 MG	$442.331
J0210	Methyldopate hcl injection	250 MG	$9.986
J0215	Alefacept	0.5 MG	$26.506
J0256	Alpha 1 proteinase inhibitor	10 MG	$3.233
J0270	Alprostadil for injection	1.25 MCG	$1.823
J0275	Alprostadil urethral suppos	125 MCG	$21.661
J0278	AMIkacin sulfate injection	50 MG	$1.304
J0280	AMInophyllin 250 MG inj	250 MG	$0.395
J0282	AMIodarone HCl	30 MG	$0.325
J0285	Amphotericin B	50 MG	$7.618			95%	$10.280
J0287	Amphotericin b lipid complex	10 MG	$11.272			95%	$21.850
J0288	Ampho b cholesteryl sulfate	10 MG	$12.000			95%	$15.200
J0289	Amphotericin b liposome inj	10 MG	$19.031			95%	$35.800
J0290	Ampicillin 500 MG inj	500 MG	$2.458
J0295	Ampicillin sodium per 1.5 gm	1.5 GM	$6.504
J0300	Amobarbital 125 MG inj	125 MG	$2.427
J0330	Succinycholine chloride inj	20 MG	$0.137
J0350	Injection anistreplase 30 u	30 UNITS	$2,268.460
J0360	Hydralazine hcl injection	20 MG	$6.088
J0365	Aprotonin, 10,000 kiu	10000 KIU	$2.333
J0456	Azithromycin	500 MG	$24.887
J0460	Atropine sulfate injection	0.3 MG	$0.398
J0470	Dimecaprol injection	100 MG	$21.802
J0475	Baclofen 10 MG injection	10 MG	$191.118			95%	$215.180
J0476	Baclofen intrathecal trial	50 MCG	$71.002			95%	$79.800
J0480	Basiliximab	20 MG	$1,410.893
J0500	Dicyclomine injection	20 MG	$15.956
J0515	Inj benztropine mesylate	1 MG	$3.873
J0530	Penicillin g benzathine inj	600000 UNITS	$13.189
J0540	Penicillin g benzathine inj	1200000 UNITS	$25.584
J0550	Penicillin g benzathine inj	2400000 UNITS	$33.479
J0560	Penicillin g benzathine inj	600000 UNITS	$19.545
J0570	Penicillin g benzathine inj	1200000 UNITS	$33.837
J0580	Penicillin g benzathine inj	2400000 UNITS	$65.719
J0583	Bivalirudin	1 MG	$1.623
J0585	Botulinum toxin a per unit	1 UNIT	$4.906
J0587	Botulinum toxin type B	100 UNITS	$7.821
J0592	Buprenorphine hydrochloride	0.1 MG	$0.751
J0595	Butorphanol tartrate 1 mg	1 MG	$0.767
J0600	Edetate calcium disodium inj	1 ML	$39.934
J0610	Calcium gluconate injection	10 ML	$0.404
J0630	Calcitonin salmon injection	400 UNITS	$37.810
J0636	Inj calcitriol per 0.1 mcg	0.1 MCG	$0.705
J0637	Caspofungin acetate	5 MG	$32.462
J0640	Leucovorin calcium injection	50 MG	$1.277
J0670	Inj mepivacaine HCL/10 ml	10 ML	$1.309
J0690	Cefazolin sodium injection	500 MG	$1.383
J0692	Cefepime HCl for injection	500 MG	$7.554
J0694	Cefoxitin sodium injection	1 GM	$7.143
J0696	Ceftriaxone sodium injection	250 MG	$5.432
J0697	Sterile cefuroxime injection	750 MG	$4.123
J0698	Cefotaxime sodium injection	1 GM	$4.348
J0702	Betamethasone acet&sod phosp	3 MG	$4.983
J0704	Betamethasone sod phosp/4 MG	4 MG	$0.907
J0706	Caffeine citrate injection	5 MG	$3.368
J0713	Inj ceftazidime per 500 mg	500 MG	$3.969
J0715	Ceftizoxime sodium / 500 MG	500 MG	$3.570
J0720	Chloramphenicol sodium injec	1 GM	$10.178
J0725	Chorionic gonadotropin/1000u	1000 UNITS	$3.722
J0740	Cidofovir injection	375 MG	$740.000
J0743	Cilastatin sodium injection	250 MG	$12.633
J0744	Ciprofloxacin iv	200 MG	$8.443
J0745	Inj codeine phosphate /30 MG	30 MG	$0.716
J0760	Colchicine injection	1 MG	$4.446
J0770	Colistimethate sodium inj	150 MG	$24.199
J0780	Prochlorperazine injection	10 MG	$3.251
J0795	Corticorelin ovine triflutal	1 EA	$4.063
J0800	Corticotropin injection	40 UNITS	$107.755
J0835	Inj cosyntropin per 0.25 MG	0.25 MG	$65.943
J0850	Cytomegalovirus imm IV /vial	1 ML	$721.415
J0878	Daptomycin injection	1 MG	$0.294
J0881	Darbepoetin alfa, non-esrd	1 MCG	$2.989
J0882	Darbepoetin alfa, esrd use	1 MCG	$2.989
J0885	Epoetin alfa, non-esrd	1000 UNITS	$9.027
J0886	Epoetin alfa, esrd	1000 UNITS	$9.570
J0895	DeferoxAMIne mesylate inj	500 MG	$15.204			95%	$15.630
J0970	Estradiol valerate injection	40 MG	$30.979
J1000	Depo-estradiol cypionate inj	5 MG	$5.292
J1020	Methylprednisolone 20 MG inj	20 MG	$2.807
J1030	Methylprednisolone 40 MG inj	40 MG	$5.270
J1040	Methylprednisolone 80 MG inj	80 MG	$9.283
J1051	Medroxyprogesterone inj	50 MG	$5.153
J1056	MA/EC contraceptiveinjection	5 MG	$22.885
J1060	Testosterone cypionate 1 ML	1 ML	$4.142
J1070	Testosterone cypionat 100 MG	100 MG	$5.156
J1080	Testosterone cypionat 200 MG	200 MG	$12.310
J1100	Dexamethasone sodium phos	1 MG	$0.121
J1110	Inj dihydroergotAMIne mesylt	1 MG	$25.341
J1120	AcetazolAMId sodium injectio	500 MG	$14.905
J1160	Digoxin injection	0.5 MG	$3.974
J1162	Digoxin immune fab (ovine)	PER VIAL	$540.910
J1165	Phenytoin sodium injection	50 MG	$0.663
J1170	Hydromorphone injection	4 MG	$1.605			95%	$1.490
J1180	Dyphylline inj	500 MG	$8.045
J1190	Dexrazoxane HCl injection	250 MG	$186.715
J1200	DiphenhydrAMIne hcl injectio	50 MG	$0.760
J1205	Chlorothiazide sodium inj	500 MG	$10.197
J1212	Dimethyl sulfoxide 50% 50 ML	50 ML	$42.368
J1230	Methadone injection	10 MG	$3.245			95%	$0.750
J1240	Dimenhydrinate injection	50 MG	$3.830
J1245	Dipyridamole injection	10 MG	$1.680
J1250	Inj dobutAMIne HCL/250 mg	250 MG	$5.024			95%	$4.740
J1260	Dolasetron mesylate	10 MG	$6.368
J1265	DopAMIne injection	40 MG	$0.709
J1270	Injection, doxercalciferol	1 MCG	$2.685
J1320	AMItriptyline injection	20 MG	$2.237
J1325	Epoprostenol injection	0.5 MG	$13.269			95%	$12.640
J1327	Eptifibatide injection	5 MG	$13.139
J1335	Ertapenem injection	500 MG	$22.254
J1364	Erythro lactobionate /500 MG	500 MG	$5.128
J1380	Estradiol valerate 10 MG inj	10 MG	$11.929
J1390	Estradiol valerate 20 MG inj	20 MG	$15.490
J1410	Inj estrogen conjugate 25 MG	25 MG	$56.668
J1430	EthanolAMIne oleate 100 mg	100 MG	$83.139
J1435	Injection estrone per 1 MG	1 MG	$0.138
J1436	Etidronate disodium inj	300 MG	$71.407
J1438	Etanercept injection	25 MG	$154.228
J1440	Filgrastim 300 mcg injection	300 MCG	$176.963
J1441	Filgrastim 480 mcg injection	480 MCG	$279.354
J1450	Fluconazole	200 MG	$14.042
J1451	Fomepizole, 15 mg	15 MG	$11.885
J1452	Intraocular Fomivirsen na	1.65 MG	$212.000
J1455	Foscarnet sodium injection	1000 MG	$9.942			95%	$13.070
J1457	Gallium nitrate injection	1 MG	$1.247
J1460	Gamma globulin 1 CC inj	1 ML	$11.633
J1470	Gamma globulin 2 CC inj	2 ML	$23.266
J1480	Gamma globulin 3 CC inj	3 ML	$34.882
J1490	Gamma globulin 4 CC inj	4 ML	$46.531
J1500	Gamma globulin 5 CC inj	5 ML	$58.164
J1510	Gamma globulin 6 CC inj	6 ML	$69.864
J1520	Gamma globulin 7 CC inj	7 ML	$81.350
J1530	Gamma globulin 8 CC inj	8 ML	$93.062
J1540	Gamma globulin 9 CC inj	9 ML	$104.797
J1550	Gamma globulin 10 CC inj	10 ML	$116.328
J1560	Gamma globulin > 10 CC inj	10 ML	$116.249
J1565	RSV-ivig	50 MG	$16.176
J1566	Immune globulin, powder	500 MG	$22.222
J1567	Immune globulin, liquid	500 MG	$28.361
J1570	Ganciclovir sodium injection	500 MG	$35.974			95%	$35.250
J1580	Garamycin gentAMIcin inj	80 MG	$0.984
J1590	Gatifloxacin injection	10 MG	$0.404
J1595	Injection glatiramer acetate	20 MG	$42.154
J1600	Gold sodium thiomaleate inj	50 MG	$4.470
J1610	Glucagon hydrochloride/1 MG	1 MG	$65.963
J1620	Gonadorelin hydroch/ 100 mcg	100 MCG	$180.295
J1626	Granisetron HCl injection	100 MCG	$6.983
J1630	Haloperidol injection	5 MG	$2.863
J1631	Haloperidol decanoate inj	50 MG	$6.217
J1640	Hemin, 1 mg	1 MG	$6.634
J1642	Inj heparin sodium per 10 u	10 UNITS	$0.049
J1644	Inj heparin sodium per 1000u	1000 UNITS	$0.210
J1645	Dalteparin sodium	2500 UNITS	$10.006
J1650	Inj enoxaparin sodium	10 MG	$5.438
J1652	Fondaparinux sodium	0.5 MG	$5.509
J1655	Tinzaparin sodium injection	1000 IU	$2.412
J1670	Tetanus immune globulin inj	250 UNITS	$90.799
J1720	Hydrocortisone sodium succ i	100 MG	$1.900
J1730	Diazoxide injection	300 MG	$111.300
J1742	Ibutilide fumarate injection	1 MG	$252.577
J1745	Infliximab injection	10 MG	$53.241
J1751	Iron dextran 165 injection	50 MG	$12.251
J1752	Iron dextran 267 injection	50 MG	$10.239
J1756	Iron sucrose injection	1 MG	$0.357
J1785	Injection imiglucerase /unit	1 UNIT	$3.908
J1790	Droperidol injection	1 MG	$0.196
J1800	Propranolol injection	1 MG	$4.553
J1810	Droperidol/fentanyl inj	2 ML	$5.576
J1815	Insulin injection	5 UNITS	$0.239
J1817	Insulin for insulin pump use	50 UNITS	$2.392			95%	$2.800
J1830	Interferon beta-1b / .25 MG	0.25 MG	$87.383
J1835	Itraconazole injection	50 MG	$36.263
J1840	Kanamycin sulfate 500 MG inj	500 MG	$3.617
J1850	Kanamycin sulfate 75 MG inj	75 MG	$0.545
J1885	Ketorolac tromethAMIne inj	15 MG	$0.471
J1931	Laronidase injection	0.1 MG	$23.868
J1940	Furosemide injection	20 MG	$0.382
J1945	Lepirudin	50 MG	$146.231
J1950	Leuprolide acetate /3.75 MG	3.75 MG	$440.596
J1955	Inj levocarnitine per 1 gm	1 G	$10.181
J1956	Levofloxacin injection	250 MG	$7.680
J1980	HyoscyAMIne sulfate inj	0.25 MG	$7.413
J1990	Chlordiazepoxide injection	100 MG	$21.050
J2001	Lidocaine injection	10 MG	$0.016
J2010	Lincomycin injection	300 MG	$3.628
J2020	Linezolid injection	200 MG	$23.795
J2060	Lorazepam injection	2 MG	$1.003
J2150	Mannitol injection	50 ML	$0.872
J2175	Meperidine hydrochl /100 MG	100 MG	$1.628			95%	$0.560
J2180	Meperidine/promethazine inj	50 MG	$3.787
J2185	Meropenem	100 MG	$3.876
J2210	Methylergonovin maleate inj	0.2 MG	$4.304
J2250	Inj midazolam hydrochloride	1 MG	$0.264
J2260	Inj milrinone lactate / 5 MG	5 ML	$3.074			95%	$51.580
J2270	Morphine sulfate injection	10 MG	$1.006			95%	$0.710
J2271	Morphine so4 injection 100mg	100 MG	$4.666			95%	$11.070
J2275	Morphine sulfate injection	10 MG	$6.071			95%	$4.390
J2278	Ziconotide injection	1 MCG	$6.172
J2280	Inj, moxifloxacin 100 mg	100 MG	$3.786
J2300	Inj nalbuphine hydrochloride	10 MG	$1.307
J2310	Inj naloxone hydrochloride	1 MG	$4.997
J2320	Nandrolone decanoate 50 MG	50 MG	$3.293
J2321	Nandrolone decanoate 100 MG	100 MG	$6.606
J2322	Nandrolone decanoate 200 MG	200 MG	$13.147
J2325	Nesiritide injection	0.1 MG	$30.086
J2353	Octreotide injection, depot	1 MG	$89.637
J2354	Octreotide inj, non-depot	25 MCG	$6.225
J2355	Oprelvekin injection	5 MG	$247.158
J2357	Omalizumab injection	5 MG	$16.284
J2360	Orphenadrine injection	60 MG	$12.666
J2370	Phenylephrine hcl injection	1 ML	$0.691
J2400	Chloroprocaine hcl injection	30 ML	$13.564
J2405	Ondansetron hcl injection	1 MG	$3.721
J2410	Oxymorphone hcl injection	1 MG	$2.242
J2425	Palifermin injection	50 MCG	$11.467
J2430	PAMIdronate disodium /30 MG	30 MG	$36.223
J2440	Papaverin hcl injection	60 MG	$0.594
J2460	Oxytetracycline injection	50 MG	$0.936
J2469	Palonosetron HCl	25 MCG	$17.993
J2501	Paricalcitol	1 MCG	$3.809
J2503	Pegaptanib sodium injection	0.3 MG	$1,054.700
J2504	Pegademase bovine, 25 iu	25 IU	$166.067
J2505	Injection, pegfilgrastim 6mg	6 MG	$2,093.436
J2510	Penicillin g procaine inj	600000 UNITS	$8.421
J2513	Pentastarch 10% solution	100 ML	$12.722
J2515	Pentobarbital sodium inj	50 MG	$5.210
J2540	Penicillin g potassium inj	600000 UNITS	$0.981
J2543	Piperacillin/tazobactam	1.125 G	$4.739
J2545	PentAMIdine isethionte/300mg	300 MG	$43.565
J2550	Promethazine hcl injection	50 MG	$2.053
J2560	Phenobarbital sodium inj	120 MG	$3.204
J2590	Oxytocin injection	10 UNITS	$1.347
J2597	Inj desmopressin acetate	1 MCG	$2.582
J2650	Prednisolone acetate inj	1 ML	$0.399
J2675	Inj progesterone per 50 MG	50 MG	$1.712
J2680	Fluphenazine decanoate 25 MG	25 MG	$1.222
J2690	ProcainAMIde hcl injection	1 GRAM	$1.527
J2700	Oxacillin sodium injeciton	250 MG	$1.520
J2710	Neostigmine methylslfte inj	0.5 MG	$0.077
J2720	Inj protAMIne sulfate/10 MG	10 MG	$0.404
J2725	Inj protirelin per 250 mcg	250 MCG	$21.783
J2730	Pralidoxime Chloride Inj	1 GM	$91.902
J2760	Phentolaine mesylate inj	5 MG	$23.486
J2765	MetocloprAMIde hcl injection	10 MG	$0.484
J2770	Quinupristin/dalfopristin	500 MG	$107.419
J2780	Ranitidine hydrochloride inj	25 MG	$0.713
J2783	Rasburicase	0.5 MG	$111.338
J2788	Rho d immune globulin 50 mcg	50 MCG	$23.509
J2790	Rho d immune globulin inj	300 MCG	$88.404
J2792	Rho(D) immune globulin h, sd	100 IU	$13.662
J2794	Risperidone, long acting	0.5 MG	$4.690
J2795	Ropivacaine HCl injection	1 MG	$0.076
J2800	Methocarbamol injection	10 ML	$8.494
J2805	Sincalide injection	5 MCG	$44.479
J2810	Inj theophylline per 40 MG	40 MG	$0.023
J2820	Sargramostim injection	50 MCG	$23.673
J2850	Inj secretin synthetic human	1 MCG	$20.313
J2910	Aurothioglucose injeciton	50 MG	$24.500
J2912	Sodium chloride injection	2 CC	$0.118
J2916	Na ferric gluconate complex	12.5 MG	$4.896
J2920	Methylprednisolone injection	40 MG	$1.917
J2930	Methylprednisolone injection	125 MG	$2.503
J2941	Somatropin injection	1 MG	$44.058
J2993	Reteplase injection	18.1 MG	$1,217.940
J2995	Inj streptokinase /250000 IU	250000 IU	$79.500
J2997	Alteplase recombinant	1 MG	$31.408
J3000	Streptomycin injection	1 G	$5.603
J3010	Fentanyl citrate injeciton	0.1 MG	$0.299			95%	$0.700
J3030	Sumatriptan succinate / 6 MG	6 MG	$50.959
J3070	Pentazocine injection	30 MG	$4.512
J3100	Tenecteplase injection	50 MG	$2,090.039
J3105	Terbutaline sulfate inj	1 MG	$5.905
J3110	Teriparatide injection	10 MCG	$7.550
J3120	Testosterone enanthate inj	100 MG	$7.274
J3130	Testosterone enanthate inj	200 MG	$14.548
J3230	Chlorpromazine hcl injection	50 MG	$3.165
J3240	Thyrotropin injection	0.9 MG	$699.282
J3246	Tirofiban HCl	0.25 MG	$7.591
J3250	TrimethobenzAMIde hcl inj	200 MG	$4.806
J3260	Tobramycin sulfate injection	80 MG	$2.016
J3265	Injection torsemide 10 mg/ml	10 MG	$2.425
J3285	Treprostinil injection	1 MG	$54.018
J3301	Triamcinolone acetonide inj	10 MG	$1.390
J3302	Triamcinolone diacetate inj	5 MG	$0.765
J3303	Triamcinolone hexacetonl inj	5 MG	$1.678
J3305	Inj trimetrexate glucoronate	25 MG	$146.660
J3315	Triptorelin pamoate	3.75 MG	$305.927
J3320	Spectinomycn di-hcl inj	2 G	$29.479
J3355	Urofollitropin, 75 iu	75 IU	$50.358
J3360	Diazepam injection	5 MG	$0.799
J3364	Urokinase 5000 IU injection	5000 IU	$9.155
J3365	Urokinase 250,000 IU inj	250000 IU	$457.729
J3370	Vancomycin hcl injection	500 MG	$3.119
J3396	Verteporfin injection	0.1 MG	$8.939
J3410	Hydroxyzine hcl injection	25 MG	$0.195
J3411	ThiAMIne hcl 100 mg	100 MG	$1.435
J3415	Pyridoxine hcl 100 mg	100 MG	$3.056
J3420	VitAMIn b12 injection	1000 MCG	$0.307
J3430	VitAMIn k phytonadione inj	1 MG	$1.864
J3465	Injection, voriconazole	10 MG	$4.603
J3470	Hyaluronidase injection	150 UNITS	$17.583
J3471	Ovine, up to 999 USP units	1 USP UNIT	$0.405
J3472	Ovine, 1000 USP units	1 USP UNIT	$135.044
J3475	Inj magnesium sulfate	500 MG	$0.124
J3480	Inj potassium chloride	2 MEQ	$0.017
J3485	Zidovudine	10 MG	$1.005
J3486	Ziprasidone mesylate	10 MG	$19.784
J3487	Zoledronic acid	1 MG	$200.451
J7030	Normal saline solution infus	1000 ML	$0.903
J7040	Normal saline solution infus	500 ML	$0.456
J7042	5% dextrose/normal saline	500 ML	$0.364
J7050	Normal saline solution infus	250 ML	$0.228
J7060	5% dextrose/water	500 ML	$1.271
J7070	D5w infusion	1000 CC	$2.308
J7100	Dextran 40 infusion	500 ML	$14.430
J7110	Dextran 75 infusion	500 ML	$8.428
J7120	Ringers lactate infusion	1000 ML	$0.884
J7188	Inj Vonwillebrand factor iu	1 IU	$0.871
J7189	Factor viia	1 MCG	$1.040
J7190	Factor viii	1 IU	$0.659
J7192	Factor viii recombinant	1 IU	$1.064
J7193	Factor IX non-recombinant	1 IU	$0.892
J7194	Factor ix complex	1 IU	$0.675
J7195	Factor IX recombinant	1 IU	$0.986
J7197	Antithrombin iii injection	1 IU	$1.659
J7198	Anti-inhibitor	1 IU	$1.304
J7308	AMInolevulinic acid hcl top	354 MG	$101.834
J7310	Ganciclovir long act implant	4.5 MG	$4,240.000
J7317	Sodium hyaluronate injection	20 - 25 MG	$111.440
J7320	Hylan G-F 20 injection	16 MG	$199.262
J7330	Cultured chondrocytes implnt	1 EA	$17,182.335
J7340	Metabolic active D/E tissue	1 SQ CM	$27.385
J7341	Non-human, metabolic tissue	1 SQ CM	$0.006
J7342	Metabolically active tissue	1 SQ CM	$15.375
J7343	Nonmetabolic act d/e tissue	1 SQ CM	$14.639
J7344	Nonmetabolic active tissue	1 SQ CM	$62.858
J7350	Injectable human tissue	10 MG	$4.105
J7500	Azathioprine oral 50mg	50 MG	$0.133
J7501	Azathioprine parenteral	100 MG	$49.306
J7502	Cyclosporine oral 100 mg	100 MG	$3.475
J7504	Lymphocyte immune globulin	250 MG	$299.240
J7505	Monoclonal antibodies	5 MG	$863.211
J7506	Prednisone oral	5 MG	$0.217
J7507	Tacrolimus oral per 1 MG	1 MG	$3.452
J7509	Methylprednisolone oral	4 MG	$0.085
J7510	Prednisolone oral per 5 mg	5 MG	$0.073
J7511	Antithymocyte globuln rabbit	25 MG	$301.888
J7513	Daclizumab, parenteral	25 MG	$357.775
J7515	Cyclosporine oral 25 mg	25 MG	$0.942
J7516	Cyclosporin parenteral 250mg	250 MG	$19.171
J7517	Mycophenolate mofetil oral	250 MG	$2.531
J7518	Mycophenolic acid	180 MG	$2.167
J7520	Sirolimus, oral	1 MG	$6.922
J7525	Tacrolimus injection	5 MG	$136.920
J7608	Acetylcysteine inh sol u d	1 G	$2.596
J7611	Albuterol concentrated form	1 MG	$0.077
J7612	Levalbuterol concentrated	0.5 MG	$0.987
J7613	Albuterol unit dose	1 MG	$0.060
J7614	Levalbuterol unit dose	0.5 MG	$1.338
J7620	Albuterol non-compounded	1 UNIT	$2.048
J7626	Budesonide, non-compounded	0.50 MG	$4.408
J7631	Cromolyn sodium inh sol u d	10 MG	$0.063
J7635	Atropine inhal sol con	1 MG	$0.119
J7636	Atropine inhal sol unit dose	1 MG	$0.119
J7637	Dexamethasone inhal sol con	1 MG	$0.102
J7638	Dexamethasone inhal sol u d	1 MG	$0.121
J7639	Dornase alpha inhal sol u d	1 MG	$18.647
J7642	Glycopyrrolate inhal sol con	1 MG	$1.186
J7643	Glycopyrrolate inhal sol u d	1 MG	$1.186
J7644	Ipratropium brom inh sol u d	1 MG	$0.227
J7669	Metaproterenol inh sol u d	10 MG	$0.232
J7674	Methacholine chloride, neb	1 MG	$0.393
J7682	Tobramycin inhalation sol	300 MG	$52.456
J8501	Oral aprepitant	5 MG	$4.635
J8510	Oral busulfan	2 MG	$1.969
J8515	Cabergoline, oral 0.25 mg	0.25 MG	$15.969
J8520	Capecitabine, oral, 150 mg	150 MG	$3.638
J8521	Capecitabine, oral, 500 mg	500 MG	$12.080
J8530	CyclophosphAMIde oral 25 MG	25 MG	$0.946
J8540	Oral dexamethasone	0.25 MG	$0.073
J8560	Etoposide oral 50 MG	50 MG	$32.170
J8610	Methotrexate oral 2.5 MG	2.5 MG	$0.281
J8700	Temozolomide	5 MG	$7.226
J9000	Doxorubic hcl 10 MG vl chemo	10 MG	$5.927
J9001	Doxorubicin hcl liposome inj	10 MG	$370.089			95%	$393.480
J9010	Alemtuzumab injection	10 MG	$518.580
J9015	Aldesleukin/single use vial	1 EA	$731.379
J9017	Arsenic trioxide	1 MG	$32.964
J9020	Asparaginase injection	10000 UNITS	$54.179
J9025	Azacitidine injection	1 MG	$4.055
J9027	Clofarabine injection	1 MG	$116.706
J9031	Bcg live intravesical vac	1 EA	$115.087
J9035	Bevacizumab injection	10 MG	$56.984
J9040	Bleomycin sulfate injection	15 UNITS	$44.939			95%	$289.370
J9041	Bortezomib injection	0.1 MG	$30.117
J9045	Carboplatin injection	50 MG	$17.088
J9050	Carmus bischl nitro inj	100 MG	$140.111
J9055	Cetuximab injection	10 MG	$49.860
J9060	Cisplatin 10 MG injection	10 MG	$1.625
J9062	Cisplatin 50 MG injection	50 MG	$11.010
J9065	Inj cladribine per 1 MG	1 MG	$38.138			95%	$61.720
J9070	CyclophosphAMIde 100 MG inj	100 MG	$2.023
J9080	CyclophosphAMIde 200 MG inj	200 MG	$4.046
J9090	CyclophosphAMIde 500 MG inj	500 MG	$15.414
J9091	CyclophosphAMIde 1.0 grm inj	1 GM	$20.229
J9092	CyclophosphAMIde 2.0 grm inj	2 GM	$40.457
J9093	CyclophosphAMIde lyophilized	100 MG	$0.363
J9094	CyclophosphAMIde lyophilized	200 MG	$0.727
J9095	CyclophosphAMIde lyophilized	500 MG	$1.817
J9096	CyclophosphAMIde lyophilized	1 GM	$3.634
J9097	CyclophosphAMIde lyophilized	2 GM	$7.268
J9098	Cytarabine liposome	10 MG	$378.806
J9100	Cytarabine hcl 100 MG inj	100 MG	$1.552			95%	$8.190
J9110	Cytarabine hcl 500 MG inj	500 MG	$7.761			95%	$8.550
J9120	Dactinomycin actinomycin d	0.5 MG	$12.625
J9130	Dacarbazine 100 mg inj	100 MG	$5.163
J9140	Dacarbazine 200 MG inj	200 MG	$10.325
J9150	Daunorubicin	10 MG	$24.051
J9151	Daunorubicin citrate liposom	10 MG	$56.246
J9160	Denileukin diftitox, 300 mcg	300 MCG	$1,410.404
J9170	Docetaxel	20 MG	$294.947
J9175	Elliotts b solution per ml	1 ML	$3.732
J9178	Inj, epirubicin hcl, 2 mg	2 MG	$24.650
J9181	Etoposide 10 MG inj	10 MG	$0.498
J9182	Etoposide 100 MG inj	100 MG	$4.980
J9185	Fludarabine phosphate inj	50 MG	$253.513
J9190	Fluorouracil injection	500 MG	$1.507			95%	$2.070
J9200	Floxuridine injection	500 MG	$60.807			95%	$136.800
J9201	Gemcitabine HCl	200 MG	$117.294
J9202	Goserelin acetate implant	3.6 MG	$196.689
J9206	Irinotecan injection	20 MG	$126.433
J9208	Ifosfomide injection	1 GM	$33.563			95%	$150.380
J9209	Mesna injection	200 MG	$9.486
J9211	Idarubicin hcl injection	5 MG	$312.228
J9212	Interferon alfacon-1	1 MCG	$3.923
J9213	Interferon alfa-2a inj	3 MIL UNITS	$33.377
J9214	Interferon alfa-2b inj	1 MIL UNITS	$13.470
J9216	Interferon gamma 1-b inj	3 MIL UNITS	$289.871
J9217	Leuprolide acetate suspnsion	7.5 MG	$236.133
J9218	Leuprolide acetate injeciton	1 MG	$9.859
J9219	Leuprolide acetate implant	65 MG	$2,246.787
J9225	Histrelin implant	50 MG	$2,524.189
J9230	MechlorethAMIne hcl inj	10 MG	$11.207
J9245	Inj melphalan hydrochl 50 MG	50 MG	$1,081.105
J9250	Methotrexate sodium inj	5 MG	$0.183
J9260	Methotrexate sodium inj	50 MG	$1.853
J9263	Oxaliplatin	0.5 MG	$8.524
J9264	Paclitaxel injection	1 MG	$8.336
J9265	Paclitaxel injection	30 MG	$15.101
J9266	Pegaspargase/singl dose vial	1 EA	$1,611.200
J9268	Pentostatin injection	10 MG	$1,946.573
J9280	Mitomycin 5 MG inj	5 MG	$19.686			95%	$127.400
J9290	Mitomycin 20 MG inj	20 MG	$78.745
J9291	Mitomycin 40 MG inj	40 MG	$157.491
J9293	Mitoxantrone hydrochl / 5 MG	5 MG	$338.685
J9300	Gemtuzumab ozogAMIcin	5 MG	$2,292.653
J9305	Pemetrexed injection	10 MG	$41.296
J9310	Rituximab cancer treatment	100 MG	$462.901
J9320	Streptozocin injection	1 GM	$152.389
J9340	Thiotepa injection	15 MG	$45.097
J9350	Topotecan	4 MG	$775.107
J9355	Trastuzumab	10 MG	$55.181			95%	$58.130
J9360	Vinblastine sulfate inj	1 MG	$0.786			95%	$4.100
J9370	Vincristine sulfate 1 MG inj	1 MG	$4.426			95%	$33.980
J9375	Vincristine sulfate 2 MG inj	2 MG	$8.852			95%	$67.960
J9380	Vincristine sulfate 5 MG inj	5 MG	$22.131			95%	$169.910
J9390	Vinorelbine tartrate/10 mg	10 MG	$38.351
J9395	Injection, Fulvestrant	25 MG	$81.416
J9600	Porfimer sodium	75 MG	$2,453.137
P9041	Albumin (human),5%, 50ml	50 ML	$11.020					95%	$11.020
P9043	Plasma protein fract,5%,50ml	50 ML	$14.545					95%	$14.545
P9045	Albumin (human), 5%, 250 ml	250 ML	$78.081					95%	$78.081
P9046	Albumin (human), 25%, 20 ml	20 ML	$22.040					95%	$22.040
P9047	Albumin (human), 25%, 50ml	50 ML	$55.100					95%	$55.100
P9048	Plasmaprotein fract,5%,250ml	250 ML	$29.099					95%	$29.099
Q0163	DiphenhydrAMIne HCl 50mg	50 MG	$0.037
Q0164	Prochlorperazine maleate 5mg	5 MG	$0.028
Q0165	Prochlorperazine maleate10mg	10 MG	$0.086
Q0166	Granisetron HCl 1 mg oral	1 MG	$37.194
Q0167	Dronabinol 2.5mg oral	2.5 MG	$4.563
Q0168	Dronabinol 5mg oral	5 MG	$9.390
Q0169	Promethazine HCl 12.5mg oral	12.5 MG	$0.303
Q0170	Promethazine HCl 25 mg oral	25 MG	$0.214
Q0171	Chlorpromazine HCl 10mg oral	10 MG	$0.025
Q0172	Chlorpromazine HCl 25mg oral	25 MG	$0.057
Q0173	TrimethobenzAMIde HCl 250mg	250 MG	$0.675
Q0174	Thiethylperazine maleate10mg	10 MG	$0.631
Q0175	Perphenazine 4mg oral	4 MG	$0.197
Q0176	Perphenazine 8mg oral	8 MG	$0.205
Q0177	Hydroxyzine pamoate 25mg	25 MG	$0.064
Q0178	Hydroxyzine pamoate 50mg	50 MG	$0.072
Q0179	Ondansetron HCl 8mg oral	8 MG	$33.640
Q0180	Dolasetron mesylate oral	100 MG	$47.677
Q0515	Sermorelin acetate injection	0.5 MG	$1.727
Q2009	Fosphenytoin, 50 mg	50 MG	$5.509
Q2017	Teniposide, 50 mg	50 MG	$266.081
Q3025	IM inj interferon beta 1-a	11 MCG	$96.329
Q4079	Natalizumab injection	1 MG	$6.387
Q4080	Iloprost inhalation solution	20 MCG	$31.111
Q9945	LOCM <=149 mg/ml iodine, 1ml	1 ML	$0.294
Q9946	LOCM 150-199mg/ml iodine,1ml	1 ML	$1.827
Q9947	LOCM 200-249mg/ml iodine,1ml	1 ML	$1.243
Q9948	LOCM 250-299mg/ml iodine,1ml	1 ML	$0.316
Q9949	LOCM 300-349mg/ml iodine,1ml	1 ML	$0.364
Q9950	LOCM 350-399mg/ml iodine,1ml	1 ML	$0.233
Q9952	Inj Gad-base MR contrast,1ml	1 ML	$2.891
Q9953	Inj Fe-based MR contrast,1ml	1 ML	$30.406
Q9954	Oral MR contrast, 100 ml	100 ML	$8.978
Q9956	Inj octafluoropropane mic,ml	1 ML	$40.417
Q9957	Inj perflutren lip micros,ml	1 ML	$61.893
	12/29/2005